What is the primary purpose of using a peak flow meter in patients with asthma?

B) To assess the maximum speed of expiration

A) To measure the amount of oxygen in the blood

B) To assess the maximum speed of expiration

C) To detect the presence of lung infections

D) To evaluate the effectiveness of corticosteroid treatment

What is the most appropriate nursing intervention to emphasize when educating a patient with mild intermittent asthma?

C) Educate on trigger avoidance and proper inhaler technique

A) Encourage daily use of the albuterol inhaler

B) Advise the patient to avoid all physical activity

C) Educate on trigger avoidance and proper inhaler technique

D) Recommend immediate use of corticosteroid inhalers

What is the primary purpose of adding a low-dose inhaled corticosteroid to an asthma management plan for a patient experiencing increased symptoms?

B) To reduce airway inflammation and prevent exacerbations

A) To provide immediate relief of asthma symptoms

B) To reduce airway inflammation and prevent exacerbations

C) To replace the use of a rescue inhaler

What is the most appropriate initial intervention for a patient with asthma who experiences increased symptoms when exposed to cold air?

C) Use a scarf to cover mouth and nose in cold weather

A) Increase use of albuterol inhaler

B) Begin low-dose inhaled corticosteroid

C) Use a scarf to cover mouth and nose in cold weather

D) Avoid all physical activities outdoors

What is the primary reason for the improvement in the patient's asthma symptoms during the follow-up visit?

B) Consistent use of the low-dose inhaled corticosteroid

A) Increased use of the albuterol inhaler

B) Consistent use of the low-dose inhaled corticosteroid

C) Reduction in physical activity levels

D) Changes in weather conditions

Which of the following is the primary purpose of using a low-dose inhaled corticosteroid in asthma management?

B) To prevent airway inflammation and reduce asthma exacerbations

A) To immediately relieve acute asthma symptoms

B) To prevent airway inflammation and reduce asthma exacerbations

C) To increase lung capacity during physical activities

D) To replace the need for a rescue inhaler

What is the primary role of an inhaled corticosteroid in the management of asthma?

B) To reduce inflammation and prevent asthma exacerbations

A) To act as a quick-relief medication during asthma attacks

B) To reduce inflammation and prevent asthma exacerbations

C) To immediately dilate the bronchioles and relieve wheezing

D) To treat acute allergic reactions associated with asthma

Which of the following actions should the nurse prioritize to help the patient manage her asthma effectively during a home renovation project?

B) Advise the patient to wear a mask and keep windows open to reduce dust exposure.

A) Encourage the patient to increase her use of the albuterol inhaler.

B) Advise the patient to wear a mask and keep windows open to reduce dust exposure.

C) Suggest the patient stop using her inhaled corticosteroid during the renovation.

D) Recommend the patient to avoid any physical activity during the renovation.

A patient with asthma and recent allergic rhinitis symptoms is experiencing nasal congestion and mild sneezing. What is the most appropriate initial non-pharmacological intervention the nurse should recommend to the patient?

C) Perform nasal saline irrigation

B) Use a humidifier in the bedroom

C) Perform nasal saline irrigation

D) Apply a warm compress to the face

What is the most appropriate initial recommendation for managing the patient's increased nasal congestion due to allergies?

B) Start using an oral antihistamine

A) Increase the frequency of her inhaled corticosteroid

B) Start using an oral antihistamine

C) Use her albuterol inhaler more frequently

D) Discontinue the asthma management plan

ASTHMA - Nursing Case Study

Pathophysiology

• Primary mechanism: In asthma, the airways become inflamed due to an overactive immune response. This inflammation leads to swelling and increased mucus production, making it difficult for air to flow freely in and out of the lungs.

• Secondary mechanism: The muscles surrounding the airways tighten, a process known as bronchoconstriction. This further narrows the airways, exacerbating breathing difficulties and causing symptoms like wheezing and shortness of breath.

• Key complication: If left unmanaged, asthma can lead to frequent asthma attacks, where symptoms suddenly worsen, potentially resulting in severe respiratory distress and requiring urgent medical intervention.

Patient Profile

Demographics:

28, female, office worker

History:

• Key past medical history: Diagnosed with mild intermittent asthma 1 year ago

• Current medications: As-needed use of albuterol inhaler

• Allergies: Mild pollen allergy

Current Presentation:

• Chief complaint: Occasional shortness of breath

• Key symptoms: Wheezing and chest tightness, primarily after physical exertion or exposure to cold air

• 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 nurse notes that the patient, a 28-year-old female office worker, appears in no acute distress but does report experiencing occasional shortness of breath, especially after climbing stairs or when exposed to cold air. Her lung auscultation reveals mild wheezing in both lung fields, particularly during expiration, but there are no signs of cyanosis or accessory muscle use at rest. The patient confirms that her symptoms are usually relieved with the use of her albuterol inhaler, which she uses roughly twice a week. Her peak flow meter readings at home have shown consistent results, averaging around 85% of her personal best, indicating that her asthma is currently well-controlled with her existing as-needed treatment regimen.

To further assess her condition, the nurse reviews the patient's recent spirometry results, which show a forced expiratory volume in one second (FEV1) within normal limits at 82% predicted, consistent with her diagnosis of mild intermittent asthma. The patient's total lung capacity and diffusion capacity are also within normal ranges, supporting the absence of significant airway obstruction or lung parenchymal disease. Given these findings, the nurse concludes that the patient's asthma is stable but emphasizes the importance of monitoring triggers such as cold air and physical exertion, encouraging the patient to continue using her inhaler as prescribed and to follow up with her healthcare provider for regular asthma reviews.

These assessment findings prompt the nurse to consider educational interventions focused on asthma management strategies, including trigger avoidance and proper inhaler technique. Additionally, the nurse plans to discuss the potential need for a more proactive asthma action plan, should the patient's symptoms begin to increase in frequency or severity, to prevent future exacerbations and ensure optimal control of her condition.

Section 2

A few weeks later, during a routine follow-up appointment, the nurse conducts another assessment to evaluate any changes in the patient’s asthma status. The patient reports that while her symptoms have generally remained stable, she has noticed a slight increase in shortness of breath over the past week, particularly when performing routine activities such as walking briskly or carrying groceries. She also mentions using her albuterol inhaler three times in the past week, slightly more than usual, though it continues to provide relief. Upon examination, her vital signs are within normal limits: heart rate 78 beats per minute, respiratory rate 18 breaths per minute, blood pressure 118/76 mmHg, and oxygen saturation at 98% on room air. However, lung auscultation reveals slightly more pronounced wheezing compared to the previous assessment, though still mild.

To investigate further, the nurse reviews the patient's updated peak flow meter readings, which show a slight decline to an average of 80% of her personal best. This change, although minor, prompts the nurse to consider potential environmental or lifestyle factors that may be contributing to the increased symptoms. The patient admits that she recently started a jogging routine in the early mornings, which may expose her to cold air, a known trigger. The nurse takes this opportunity to reinforce the importance of warming up indoors before exercise and wearing a scarf to cover her mouth and nose in cold weather.

Given these findings, the nurse discusses with the patient the potential benefits of adjusting her asthma management plan. The nurse suggests the addition of a low-dose inhaled corticosteroid as a daily preventive measure, while still using the albuterol inhaler for acute relief. The patient agrees to discuss this potential adjustment with her primary care provider. The nurse emphasizes the importance of adhering to the asthma action plan and scheduling another follow-up to re-evaluate her asthma control, ensuring that any changes in her condition are addressed promptly to maintain her quality of life.

Section 3

Two weeks after the adjustment to the asthma management plan, the patient returns for another follow-up appointment. During the visit, she reports feeling more in control of her symptoms, with a noticeable reduction in shortness of breath during routine activities. She has only used her albuterol inhaler once in the past week, primarily after a particularly brisk jog on a chilly morning. The nurse notes that the patient's adherence to the new regimen, including the use of the low-dose inhaled corticosteroid, has been consistent.

Upon conducting a physical assessment, the nurse finds that the patient's vital signs remain stable: heart rate 76 beats per minute, respiratory rate 16 breaths per minute, blood pressure 116/74 mmHg, and oxygen saturation at 99% on room air. Lung auscultation reveals minimal wheezing, much improved from the previous visit. The nurse reviews the patient's peak flow meter readings, which have returned to an average of 90% of her personal best, indicating improved lung function.

The nurse discusses these positive changes with the patient, reinforcing the importance of continuing her current management plan. The nurse also takes the opportunity to educate the patient on the potential signs of exacerbation, emphasizing the importance of early intervention. The patient feels encouraged and expresses confidence in managing her asthma effectively. The nurse schedules another follow-up in a month to ensure sustained control and to address any new developments, keeping the focus on maintaining the patient’s quality of life and preventing future complications.

Section 4

One month later, the patient returns for her scheduled follow-up appointment. She continues to report feeling well and has maintained consistent use of her low-dose inhaled corticosteroid, using her albuterol inhaler sparingly—only twice since her last visit. The patient notes that both instances of using the rescue inhaler were due to exposure to her known triggers: cold air and dust from a brief home renovation project. She expresses confidence in recognizing and avoiding triggers where possible and is diligent with her peak flow monitoring.

During the physical assessment, the nurse observes stable vital signs, with a heart rate of 74 beats per minute, respiratory rate of 18 breaths per minute, blood pressure of 112/76 mmHg, and oxygen saturation holding steady at 98% on room air. Lung auscultation reveals no wheezing, and the patient's peak flow meter readings consistently show 92% of her personal best. The nurse is pleased to see these improvements and commends the patient on her successful management of her asthma. However, upon reviewing the patient's recent lab results, a minor elevation in the patient's eosinophil count is noted, suggesting a mild allergic response, likely related to her recent exposure to dust.

The nurse takes this opportunity to discuss strategies for managing allergic triggers and reinforces the importance of maintaining a clean living environment, particularly during renovation activities. The nurse also advises the patient to monitor for any new or worsening symptoms that might indicate an exacerbation. The patient is encouraged to continue her current management plan and is scheduled for another follow-up in two months. This proactive approach aims to further stabilize her condition and prevent any potential complications, ensuring she maintains a high quality of life.

Section 5

Two months later, the patient returns for her scheduled follow-up appointment. She reports feeling generally well but mentions a recent increase in nasal congestion and mild sneezing, particularly in the mornings. She attributes these symptoms to seasonal allergies, which she has experienced in the past but have been more pronounced recently. The patient confirms adherence to her asthma management plan, including consistent use of her inhaled corticosteroid and peak flow monitoring, which continues to show readings around 90% of her personal best. She has not needed her albuterol inhaler since the last visit.

During the physical assessment, the nurse notes that the patient's vital signs remain stable: heart rate at 76 beats per minute, respiratory rate at 18 breaths per minute, blood pressure at 114/78 mmHg, and oxygen saturation at 98% on room air. Lung auscultation continues to show clear breath sounds without wheezing. However, the nurse observes mild nasal congestion and slight erythema of the nasal mucosa, indicating allergic rhinitis. The nurse discusses the possibility of incorporating an antihistamine or nasal corticosteroid spray to address these new symptoms and suggests the patient follow up with her primary care provider for further evaluation.

The nurse emphasizes the importance of continued monitoring for any changes in asthma symptoms, particularly as the allergy season progresses. The patient is advised to keep a symptom diary to help identify any patterns or triggers that may require adjustments to her management plan. The nurse reminds the patient of the importance of avoiding known allergens and maintaining a clean environment to minimize exposure. The patient expresses understanding and is scheduled for another follow-up in three months, with a recommendation to contact the healthcare team if her symptoms worsen or if she requires increased use of her rescue inhaler. This vigilant approach aims to manage her allergic symptoms effectively while preventing any impact on her asthma control.