What is the most appropriate initial nursing intervention for Mrs. Johnson, who is experiencing a mild exacerbation of asthma with stable oxygen saturation?

C) Position the patient in high Fowler's position

A) Administer supplemental oxygen

B) Encourage pursed-lip breathing

C) Position the patient in high Fowler's position

Based on the initial assessment findings, which intervention should the nurse prioritize for Mrs. Johnson experiencing a mild exacerbation of asthma?

C) Administer a prescribed short-acting bronchodilator inhaler.

A) Administer supplemental oxygen at 2 liters per minute via nasal cannula.

B) Encourage Mrs. Johnson to perform diaphragmatic breathing exercises.

C) Administer a prescribed short-acting bronchodilator inhaler.

D) Restrict Mrs. Johnson's fluid intake to prevent pulmonary edema.

A nurse is caring for a patient with a mild asthma exacerbation presenting with respiratory acidosis. Which of the following interventions should the nurse prioritize to address the patient's condition?

B) Provide nebulized albuterol treatment

A) Administer intravenous fluids

B) Provide nebulized albuterol treatment

C) Initiate supplemental oxygen therapy

D) Encourage deep breathing exercises

Which of the following interventions is most appropriate for the nurse to implement first for a patient experiencing a mild asthma exacerbation with respiratory acidosis?

A) Administer bronchodilator therapy

C) Encourage deep breathing and coughing exercises

D) Provide education on trigger avoidance

What is the primary reason for reinforcing the importance of nutrition and hydration in Mrs. Johnson's care plan?

B) To maintain electrolyte balance

A) To enhance the effectiveness of albuterol

B) To maintain electrolyte balance

D) To improve respiratory function

What dietary advice should the nurse provide to Mrs. Johnson to help maintain her potassium levels within the normal range?

B) Incorporate more bananas and oranges into her diet

A) Increase intake of processed foods

B) Incorporate more bananas and oranges into her diet

C) Limit fluid intake to prevent dilution of electrolytes

Which of the following nursing interventions is most appropriate for Mrs. Johnson, considering her mild shortness of breath and wheezing post-exercise?

A) Administer a bronchodilator as needed before her evening walks

B) Advise complete rest and avoid any physical activity

C) Increase her fluid intake to improve oxygenation

D) Recommend doubling her daily asthma medication dosage

Which of the following actions should the nurse prioritize for Mrs. Johnson based on her reported symptoms and assessment findings?

B) Advise Mrs. Johnson to use her rescue inhaler before her evening walks.

A) Encourage Mrs. Johnson to increase her evening walks to improve lung function.

B) Advise Mrs. Johnson to use her rescue inhaler before her evening walks.

C) Suggest Mrs. Johnson avoid all physical activity until her next appointment.

D) Recommend Mrs. Johnson initiate a low-sodium diet to manage her symptoms.

ABG - Nursing Case Study

Pathophysiology

• Primary mechanism: Respiratory Acidosis - Occurs when lungs can't remove enough CO2, leading to increased acidity. Common in conditions like COPD, where airway obstruction limits CO2 exhalation.

• Secondary mechanism: Metabolic Acidosis - Results from excess acid or decreased bicarbonate in the body. Often due to kidney failure or diabetic ketoacidosis, where kidneys can't excrete enough acid or conserve bicarbonate.

• Key complication: Impaired Oxygen Delivery - Acidosis can impair hemoglobin's ability to carry oxygen, reducing tissue oxygenation and potentially leading to organ dysfunction if not corrected.

Patient Profile

Demographics:

45-year-old female, teacher

History:

• Key past medical history: Mild asthma

• Current medications: Albuterol inhaler as needed

• Allergies: No known drug allergies

Current Presentation:

• Chief complaint: Mild shortness of breath

• Key symptoms: Occasional wheezing, slight chest tightness

• Vital signs: Blood pressure 118/76 mmHg, heart rate 82 bpm, respiratory rate 18 breaths per minute, temperature 98.4°F, oxygen saturation 96% on room air

Section 1

Initial Assessment Findings:

Upon further assessment, the nurse observes that the patient, Mrs. Johnson, is alert and oriented but appears slightly anxious due to her breathing difficulty. Her skin is warm and dry, and she maintains a calm demeanor despite her discomfort. Auscultation of the lungs reveals mild wheezing, particularly in the expiratory phase, consistent with her history of asthma. Her respiratory effort is slightly increased but not labored, and she demonstrates no use of accessory muscles during breathing.

The nurse conducts a focused respiratory assessment and notes that Mrs. Johnson's oxygen saturation remains stable at 96% on room air, indicating adequate oxygenation at this stage. The nurse performs a peak flow measurement, which shows a mild reduction from her baseline, suggesting some degree of airflow limitation. Her capillary refill time is less than 2 seconds, indicating good peripheral perfusion. Additionally, the nurse assesses the patient's ability to speak in full sentences without significant distress, reinforcing the stability of her current respiratory status.

These findings suggest that Mrs. Johnson is experiencing a mild exacerbation of her asthma, likely contributing to her respiratory acidosis. The nurse plans to collaborate with the healthcare team to consider a possible adjustment in her asthma management, focusing on optimizing bronchodilation and monitoring her response to treatment. The goal is to prevent further deterioration and address the minor complications early, ensuring Mrs. Johnson's comfort and stability.

Section 2

The nurse decides to proceed with obtaining an arterial blood gas (ABG) test to further assess Mrs. Johnson's respiratory status and acid-base balance. The ABG results reveal a pH of 7.33, indicating mild acidosis, with a partial pressure of carbon dioxide (PaCO2) elevated at 48 mmHg, suggesting respiratory acidosis. The bicarbonate level is slightly elevated at 27 mEq/L, reflecting some renal compensation. These findings confirm that Mrs. Johnson's mild asthma exacerbation has led to a minor respiratory acidosis, which aligns with her clinical presentation of increased respiratory effort and wheezing.

Recognizing the need for intervention, the nurse collaborates with the healthcare team to initiate bronchodilator therapy. Mrs. Johnson receives a nebulized albuterol treatment to help open her airways and improve airflow. The nurse monitors her response to the medication closely, assessing her respiratory rate, which decreases slightly to 18 breaths per minute following the treatment. Mrs. Johnson reports feeling less anxious and notes an improvement in her ability to breathe more comfortably. Her wheezing diminishes, particularly on expiration, and her peak flow measurement shows a modest increase towards her baseline, indicating a positive response to the intervention.

As Mrs. Johnson stabilizes, the nurse emphasizes the importance of asthma education, reviewing with her the proper use of inhalers and the significance of adhering to her asthma action plan. The nurse also discusses potential triggers to avoid and the importance of regular follow-up appointments to manage her asthma effectively. Mrs. Johnson expresses understanding and appreciation for the care provided, feeling more confident in managing her asthma moving forward. With her condition stable, the healthcare team plans for her discharge, ensuring she has the resources and knowledge to prevent future exacerbations.

Section 3

As Mrs. Johnson continues her recovery, the nurse remains vigilant in monitoring for any new complications or changes in her status. During a routine assessment, the nurse notes that Mrs. Johnson's respiratory rate remains stable at 18 breaths per minute, but she appears slightly fatigued and mentions feeling a bit dizzy when she stands up. Recognizing the potential for dehydration or electrolyte imbalance, the nurse decides to check Mrs. Johnson's vital signs and conducts a brief physical exam. Her blood pressure is recorded at 110/70 mmHg, slightly lower than her baseline, and her heart rate is 88 beats per minute, which is within normal limits but slightly elevated for her.

To further investigate these symptoms, the nurse requests basic laboratory tests, including a complete blood count (CBC) and serum electrolytes. The results reveal that Mrs. Johnson has a mild decrease in her potassium levels, with a reading of 3.4 mEq/L, slightly below the normal range. This finding suggests that the use of albuterol, a known side effect of which can be hypokalemia, may have contributed to her dizziness and fatigue. The healthcare team decides to address this by encouraging oral hydration and considering a potassium supplement to correct the imbalance.

The nurse educates Mrs. Johnson about the importance of maintaining adequate hydration, especially when using bronchodilators, and advises her to include potassium-rich foods in her diet, such as bananas and oranges. Mrs. Johnson acknowledges her understanding and agrees to follow the dietary recommendations. With her potassium level being monitored, the healthcare team feels confident in Mrs. Johnson's ability to continue her recovery at home. The plan for her discharge proceeds, ensuring she has clear instructions and access to resources to address any future issues related to her asthma and overall health.

Section 4

A few days after addressing Mrs. Johnson's mild hypokalemia, the nurse conducts a follow-up assessment to evaluate her response to the interventions implemented. Mrs. Johnson reports feeling more energetic and notes a decrease in dizziness since she began increasing her fluid intake and incorporating potassium-rich foods into her diet. Her current vital signs show a stable respiratory rate of 18 breaths per minute, blood pressure of 115/75 mmHg, and a heart rate of 80 beats per minute, all of which are within normal limits and closer to her baseline. These findings suggest an improvement in her overall condition, indicating that the initial interventions were effective.

To ensure the resolution of her electrolyte imbalance, a repeat serum electrolyte panel is drawn. The results show that her potassium level has increased to 3.8 mEq/L, now within the normal range of 3.5-5.0 mEq/L. This positive change confirms that the dietary adjustments and hydration efforts have been successful in addressing the mild hypokalemia. The nurse takes this opportunity to reinforce the importance of continuing these healthy habits, emphasizing the role of nutrition and hydration in maintaining electrolyte balance, especially with her ongoing use of albuterol for asthma management.

As Mrs. Johnson prepares for discharge, the healthcare team provides her with a comprehensive care plan, including clear instructions on medication management, dietary guidelines, and follow-up appointments. They also ensure she has access to resources such as a nutritionist, should she need further dietary advice. With her condition stabilized and her understanding of self-care reinforced, Mrs. Johnson feels confident and well-supported in managing her health at home. The team encourages her to contact her healthcare provider if she experiences any new symptoms or concerns, aiming to prevent future complications and promote her long-term well-being.

Section 5

A week after Mrs. Johnson's discharge, she returns to the clinic for a scheduled follow-up appointment. The nurse conducts a thorough assessment to evaluate her continued progress and adherence to the care plan. Mrs. Johnson reports that she has been diligently following the dietary guidelines and hydration recommendations. She mentions feeling generally well but has noticed occasional episodes of mild shortness of breath after her evening walks, which subside with rest.

During the assessment, Mrs. Johnson's vital signs remain stable: her respiratory rate is 20 breaths per minute, blood pressure is 118/76 mmHg, and heart rate is 82 beats per minute. Her oxygen saturation level is 96% on room air, which is slightly lower than her baseline but still within normal limits. The nurse notes mild wheezing upon auscultation of her lung fields, more pronounced on expiration. Given her history of asthma and recent adjustments to her routine, the nurse considers the possibility of her symptoms being related to either her asthma management or a subtle change in her respiratory condition.

To gain further insight, the nurse arranges for a repeat arterial blood gas (ABG) test to assess Mrs. Johnson's respiratory status more comprehensively. The results show a pH of 7.39, a PaCO2 of 44 mmHg, and a PaO2 of 78 mmHg, suggesting a slight respiratory compromise but no acute distress. The nurse discusses these findings with Mrs. Johnson, reassuring her that the current management plan is effective but emphasizing the importance of monitoring her symptoms closely. The nurse suggests a follow-up appointment with her primary care provider and possibly adjusting her asthma action plan to better accommodate her physical activity, aiming to prevent further exacerbations and maintain her well-being.