Which of the following is the primary purpose of using a peak flow meter for a patient with asthma?

C) To determine the degree of airway obstruction

A) To measure oxygen saturation levels

B) To assess blood pressure variations

C) To determine the degree of airway obstruction

D) To monitor heart rate fluctuations

Which of the following actions is most important for the nurse to emphasize to the patient to help prevent asthma exacerbations?

A) Increase physical activity levels

B) Use the inhaler only when symptoms are severe

D) Reduce fluid intake to decrease mucus production

Which of the following interventions should a nurse prioritize for a patient experiencing nighttime asthma symptoms?

B) Recommend taking the asthma inhaler before sleep

A) Suggest the patient increase physical activity before bedtime

B) Recommend taking the asthma inhaler before sleep

C) Advise the patient to drink caffeinated beverages before bed

D) Encourage the patient to sleep with windows open for fresh air

The patient reports experiencing nighttime coughing associated with her asthma. Which of the following interventions should the nurse prioritize to help manage her symptoms effectively?

A) Advise the patient to use her inhaler before bedtime.

B) Recommend drinking herbal tea to soothe her throat before sleeping.

C) Suggest sleeping with a window open for fresh air.

D) Encourage the use of a humidifier in the bedroom.

Which of the following actions taken by the patient is most effective in reducing nighttime asthma symptoms?

A) Using an inhaler before bedtime

C) Avoiding the use of allergen-proof covers

D) Not tracking symptoms in a diary

Which intervention has MOST likely contributed to the patient's improved nighttime coughing and sleep quality?

B) Using the inhaler before bedtime

A) Increasing water intake before bedtime

B) Using the inhaler before bedtime

C) Sleeping with the windows open

D) Taking antihistamines every morning

Which intervention is most appropriate for a patient presenting with symptoms of allergic rhinitis, such as nasal congestion and sneezing, particularly in the mornings?

A) Administering a bronchodilator

C) Encouraging increased fluid intake

D) Initiating antibiotic therapy

A patient with asthma reports new nasal congestion and occasional sneezing, particularly in the mornings. Which of the following interventions should the nursing team prioritize to address these symptoms?

B) Educate the patient on using a saline nasal spray

A) Increase the dose of the patient's rescue inhaler

B) Educate the patient on using a saline nasal spray

C) Recommend reducing fluid intake to decrease mucus production

D) Advise the patient to avoid exercise until symptoms resolve

What is the primary reason for recommending intranasal corticosteroids for the patient's nasal symptoms?

A) To reduce nasal congestion by decreasing inflammation

B) To eliminate any potential infectious causes

C) To increase oxygen saturation levels

D) To prevent asthma exacerbations

What is the primary purpose of starting an intranasal corticosteroid for the patient with allergic rhinitis, as discussed by the nursing team?

B) To directly reduce nasal congestion and sneezing symptoms

A) To improve asthma control by reducing airway inflammation

B) To directly reduce nasal congestion and sneezing symptoms

C) To eliminate the need for a symptom diary

D) To treat any underlying infectious cause of nasal symptoms

asthma - Nursing Case Study

Pathophysiology

• Primary mechanism: Inflammation—The airway linings become inflamed, causing swelling and narrowing, which restricts airflow and makes breathing difficult.

• Secondary mechanism: Bronchoconstriction—The muscles around the airways tighten in response to triggers, further narrowing the airways and limiting air passage.

• Key complication: Increased mucus production—Inflamed airways produce extra mucus, leading to blockage and additional airway obstruction, which can exacerbate breathing difficulties.

Patient Profile

Demographics:

26-year-old female, office worker

History:

• Key past medical history: Diagnosed with asthma 2 years ago, no hospitalizations or emergency visits related to asthma

• Current medications: Inhaled short-acting beta-agonist as needed

• Allergies: None known

Current Presentation:

• Chief complaint: Occasional shortness of breath

• Key symptoms: Wheezing and mild shortness of breath during exercise, resolved with inhaler use

• 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:

During the initial nursing assessment, the patient, a 26-year-old female with a history of asthma, presents with occasional shortness of breath primarily triggered by physical activity. Upon auscultation, mild wheezing is noted in the bilateral lung fields, more pronounced during expiration. The patient's breathing pattern appears slightly labored during moderate exertion but improves with rest and the use of her prescribed inhaler. A brief assessment of the patient's inhaler technique reveals that she uses it correctly, ensuring optimal medication delivery.

The patient's peak flow meter readings, taken during the assessment, indicate a slight reduction in her peak expiratory flow rate (PEFR) at 80% of her personal best. This suggests mild airway obstruction but remains within the range that is typically managed with her current treatment plan. The patient's recent activity levels and potential environmental triggers, such as dust exposure in her office environment, are discussed to identify any factors contributing to her symptoms.

Based on these findings, the nursing team reinforces the importance of avoiding known triggers and adhering to her asthma action plan. Education is provided on recognizing early signs of worsening asthma and the appropriate use of her inhaler to prevent exacerbations. The patient is advised to monitor her symptoms closely and is scheduled for a follow-up appointment to reassess her condition and adjust her management plan if necessary. This approach aims to maintain her asthma control and prevent progression to more severe symptoms or complications.

Section 2

A week after the initial assessment, the patient returns for her scheduled follow-up appointment. During this visit, she reports an improvement in her symptoms after implementing the recommended changes, such as minimizing exposure to dust in her office by using an air purifier and taking regular breaks during physical activity. However, she notes experiencing some nighttime coughing over the past two nights, which disturbed her sleep.

Upon re-evaluation, the nursing team conducts a comprehensive assessment. The patient's vital signs are stable: blood pressure is 118/76 mmHg, heart rate is 78 beats per minute, and respiratory rate is 16 breaths per minute. Oxygen saturation remains at 98% on room air. Auscultation reveals that wheezing is still present but less pronounced compared to the previous visit. A repeat peak flow meter test shows her PEFR has improved slightly to 85% of her personal best. Although this indicates better airway function, the nighttime symptoms suggest a need for closer monitoring.

Based on these findings, the nursing team discusses the potential need for adjusting her asthma management plan. They educate the patient on strategies to manage nighttime symptoms, such as using her inhaler before bed and ensuring her sleeping environment is free of allergens. The importance of continued adherence to her asthma action plan is emphasized, and she is encouraged to keep a symptom diary to help identify any patterns or triggers. A follow-up appointment is scheduled in two weeks to further assess her progress and determine if additional interventions are necessary to maintain optimal asthma control.

Section 3

Two weeks later, the patient returns for her follow-up appointment. She reports significant improvement in her nighttime coughing after implementing the strategies discussed during her last visit. She has been using her inhaler before bedtime and has taken steps to reduce allergens in her bedroom, such as encasing pillows and mattresses in allergen-proof covers and keeping pets out of the room. As a result, her sleep quality has improved, and she feels more rested during the day.

During this visit, the nursing team conducts another comprehensive assessment. Her vital signs remain stable: blood pressure is 116/74 mmHg, heart rate is 76 beats per minute, and respiratory rate is 16 breaths per minute. Oxygen saturation continues to hold at 98% on room air. Upon auscultation, the wheezing has diminished further, and breath sounds are clearer. A repeat peak flow meter test reveals her PEFR has improved to 90% of her personal best, indicating further enhancement in her airway function.

While the improvements are encouraging, the nursing team notes the importance of continued vigilance and adherence to the asthma action plan, particularly as seasonal changes can influence asthma symptoms. They remind the patient to continue monitoring her symptoms and using her symptom diary to track any new patterns or potential triggers. The team also discusses the possibility of stepping down her medication if her condition remains stable over the next few months. A follow-up appointment is scheduled for one month later to ensure ongoing stability and to review her long-term asthma management plan.

Section 4

At the one-month follow-up appointment, the patient reports continued improvement with few daytime symptoms and only occasional need for her rescue inhaler. However, she mentions a recent increase in nasal congestion and occasional sneezing, particularly in the mornings. The nursing team conducts a focused assessment, noting that her vital signs remain stable: blood pressure is 114/72 mmHg, heart rate is 74 beats per minute, and respiratory rate is 18 breaths per minute. Oxygen saturation is 97% on room air. Upon auscultation, breath sounds are clear bilaterally with no wheezing detected. Her peak expiratory flow rate (PEFR) holds steady at 88% of her personal best, suggesting maintained airway function.

Given the recent onset of nasal symptoms, the nursing team considers the possibility of allergic rhinitis as a contributing factor. They review her current management plan and reinforce strategies to minimize exposure to potential allergens, such as using a saline nasal spray to alleviate congestion and continuing to minimize dust accumulation in her living space. A nasal swab is taken to rule out any infectious causes, and an allergist referral is offered for further evaluation if symptoms persist.

The nursing team emphasizes the importance of continuing her symptom diary, now including the new nasal symptoms, to identify any correlations with environmental changes. They also discuss the potential adjustment of her medication regimen to address both asthma and rhinitis if necessary. The patient is encouraged to maintain her current asthma management strategies while remaining vigilant for any new symptoms. A follow-up appointment is scheduled in six weeks to reassess her condition and evaluate the effectiveness of the current interventions.

Section 5

At the six-week follow-up appointment, the patient reports that her nasal symptoms have persisted, although they have not worsened. She continues to experience nasal congestion and sneezing primarily in the mornings, which she has diligently recorded in her symptom diary. Her asthma remains well-controlled, with no significant increase in daytime symptoms or rescue inhaler use. The nursing team conducts a thorough assessment, noting that her vital signs continue to be stable: blood pressure is 116/70 mmHg, heart rate is 76 beats per minute, respiratory rate is 18 breaths per minute, and oxygen saturation is 98% on room air. Lung auscultation reveals clear breath sounds bilaterally, and there is no evidence of wheezing or respiratory distress. The patient’s peak expiratory flow rate (PEFR) remains at 87% of her personal best, indicating stable airway function.

The results of the nasal swab taken during the previous visit return negative for infectious causes, reinforcing the suspicion of allergic rhinitis. The nursing team reviews the patient's symptom diary and identifies a possible correlation between her nasal symptoms and increased time spent outdoors on high pollen days. Based on these findings, the team discusses the potential benefits of starting an intranasal corticosteroid to address her nasal symptoms, in addition to continuing her saline nasal spray. They also recommend environmental control measures, such as keeping windows closed during peak pollen times and using air purifiers at home.

The patient feels reassured by the consistent improvement in her asthma control and is willing to try the new recommendations for her nasal symptoms. The nursing team emphasizes the importance of adherence to both asthma and allergic rhinitis management plans and encourages her to continue monitoring her symptoms. A follow-up appointment is scheduled in another six weeks to further evaluate her response to the interventions and make any necessary adjustments to her management plan.