A patient with asthma presents with increased work of breathing, diffuse wheezing, and diminished breath sounds. An ABG analysis shows respiratory acidosis with hypoxemia. Which nursing intervention is the priority to address the patient's current respiratory status?

A) Administer a bronchodilator and reassess the patient's respiratory status.

B) Encourage the patient to use pursed-lip breathing to improve oxygenation.

C) Elevate the head of the bed to reduce the work of breathing.

D) Prepare the patient for possible intubation and mechanical ventilation.

A patient with asthma is experiencing increased work of breathing, nocturnal dyspnea, and decreased peak flow readings. An ABG analysis shows respiratory acidosis with hypoxemia. As the nurse, what is the most appropriate initial intervention to improve the patient's respiratory status?

B) Administer a rapid-acting bronchodilator to relieve bronchospasm

A) Initiate supplemental oxygen therapy to improve oxygenation

B) Administer a rapid-acting bronchodilator to relieve bronchospasm

C) Begin systemic corticosteroids to reduce airway inflammation

D) Educate the patient on deep breathing exercises to increase lung expansion

A patient with asthma is admitted to the step-down unit due to worsening respiratory distress despite treatment with systemic and inhaled corticosteroids. The patient's ABG results show a pH of 7.34, PaCO2 of 46 mmHg, and PaO2 of 62 mmHg. Which of the following nursing interventions is the most appropriate to address the patient's current clinical status?

C) Prepare the patient for a bronchoscopy procedure as ordered by the physician.

A) Increase the supplemental oxygen to 4 liters per minute via nasal cannula.

B) Encourage the patient to perform incentive spirometry every hour while awake.

C) Prepare the patient for a bronchoscopy procedure as ordered by the physician.

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

A patient with asthma is experiencing persistent dyspnea and hypoxemia despite treatment with systemic and inhaled corticosteroids, as well as a LABA. A bronchoscopy is planned to assess for potential obstructions such as mucus plugs. What is the nurse's priority action to prepare the patient for the procedure?

A) Ensure the patient has been NPO for at least 6 hours prior to the procedure.

B) Administer a bronchodilator immediately before the procedure.

C) Educate the patient on the importance of deep breathing exercises post-procedure.

D) Verify the patient's allergy status and document any reactions to contrast agents.

A patient with asthma underwent a bronchoscopy that revealed significant mucus plugging, contributing to ventilation-perfusion mismatch. Post-procedure, the patient shows partial improvement but continues to experience moderate dyspnea and fatigue. Her management plan includes increased inhaled corticosteroids and oral antibiotics. Which nursing intervention is most critical to prioritize for this patient?

A) Educate the patient on proper inhaler technique to ensure effective medication delivery.

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

C) Monitor the patient closely for signs of bronchospasm or bleeding post-procedure.

D) Advise the patient to perform deep breathing exercises to promote lung expansion.

A patient with asthma underwent a bronchoscopy to remove mucus plugs, which resulted in a modest improvement in oxygenation but persistent respiratory symptoms. Which nursing intervention is most appropriate to support the patient's ongoing care plan?

A) Encourage the patient to use a peak flow meter daily to monitor asthma control.

B) Suggest the patient increase physical activity to improve lung function.

C) Advise the patient to use a humidifier continuously to loosen mucus secretions.

D) Recommend the patient avoid all physical activity to prevent respiratory distress.

A patient with asthma presents with wheezing, chest tightness, and productive cough with yellow-green sputum. Sputum culture reveals Haemophilus influenzae. What is the most appropriate nursing intervention to prioritize in this situation to prevent further exacerbation of asthma symptoms?

A) Educate the patient on proper inhaler technique and adherence to the medication regimen.

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

C) Advise the patient to avoid known allergens and irritants in the home environment.

D) Recommend the patient engage in moderate exercise to improve lung function.

A patient with asthma exacerbation due to Haemophilus influenzae presents with ongoing symptoms despite initial treatment adjustments. Which nursing intervention is most appropriate to prioritize during this follow-up visit?

D) Reinforce the correct technique for using inhaled corticosteroids and ensure adherence.

A) Encourage the patient to use a peak flow meter daily to monitor asthma control.

B) Advise the patient to increase fluid intake to help thin the yellow-green sputum.

C) Emphasize the importance of avoiding known asthma triggers such as allergens.

D) Reinforce the correct technique for using inhaled corticosteroids and ensure adherence.

A patient with asthma presents with persistent nocturnal symptoms and decreased peak expiratory flow rate despite adherence to treatment. Which nursing intervention should be prioritized to address the patient's current respiratory status?

A) Administer a short-acting bronchodilator as prescribed

B) Educate the patient on relaxation techniques to reduce anxiety

C) Increase the frequency of peak flow monitoring

D) Encourage the patient to increase fluid intake

A patient with asthma returns for a follow-up appointment reporting persistent nocturnal symptoms and increased fatigue despite adherence to her treatment plan. Her vital signs indicate a respiratory rate of 24 breaths per minute and an oxygen saturation of 92% on room air. A repeat pulmonary function test shows a peak expiratory flow rate at 60% of her personal best. Which of the following interventions should the nurse prioritize to address the current situation?

B) Administer systemic corticosteroids as prescribed to reduce airway inflammation

A) Educate the patient on proper inhaler technique to improve medication delivery

B) Administer systemic corticosteroids as prescribed to reduce airway inflammation

C) Encourage the patient to increase fluid intake to thin respiratory secretions

D) Recommend the use of a peak flow meter at home to monitor daily lung function

Asthma - Nursing Case Study

Pathophysiology

• Primary mechanism: Inflammation and hyperresponsiveness of the airways lead to bronchoconstriction. This is triggered by exposure to allergens or irritants, causing immune cells to release inflammatory mediators like histamines and leukotrienes.

• Secondary mechanism: Airway remodeling occurs due to chronic inflammation, leading to structural changes such as thickening of the airway walls and increased mucus production. This results in persistent airflow obstruction and reduced lung function over time.

• Key complication: Frequent asthma exacerbations can lead to respiratory distress and decreased quality of life, and in severe cases, may progress to respiratory failure if not adequately managed.

Patient Profile

Demographics:

35 years old, female, office worker

History:

• Key past medical history: Diagnosed with asthma 10 years ago, seasonal allergies, occasional GERD

• Current medications: Inhaled corticosteroid (Fluticasone), short-acting beta agonist (Albuterol), antihistamine (Cetirizine) as needed

• 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 and early morning, fatigue

• Vital signs: Blood pressure 138/88 mmHg, heart rate 102 bpm, respiratory rate 24 breaths per minute, oxygen saturation 92% on room air, temperature 98.7°F

Section 1

Over the following days, the patient's condition shows signs of deterioration, prompting the healthcare team to conduct a more detailed assessment. On physical examination, the patient is observed to have increased work of breathing, with the use of accessory muscles and nasal flaring. Auscultation reveals diffuse wheezing and diminished breath sounds in the lower lung fields, suggesting worsening airway obstruction. The patient reports difficulty sleeping due to nocturnal dyspnea and an increase in the use of her rescue inhaler, Albuterol, with little relief. Her peak flow readings have decreased significantly from her personal best, indicating a reduction in her expiratory flow.

As part of the evaluation, an arterial blood gas (ABG) analysis is performed, which shows a pH of 7.32, partial pressure of carbon dioxide (PaCO2) at 48 mmHg, and partial pressure of oxygen (PaO2) at 58 mmHg. These results indicate respiratory acidosis with hypoxemia, a sign that her asthma is progressing towards a more severe exacerbation. The elevated PaCO2 suggests that the patient is beginning to have difficulty expelling carbon dioxide, a potential precursor to respiratory failure if not addressed promptly. Additionally, a chest X-ray is ordered to rule out other potential causes of her symptoms, such as pneumonia or pneumothorax, and it shows hyperinflation of the lungs, consistent with her obstructive airway disease.

This clinical scenario necessitates a reassessment of her asthma management plan, focusing on both pharmacological and non-pharmacological strategies. The healthcare team considers the initiation of systemic corticosteroids to address the acute inflammation and a possible adjustment in her maintenance therapy to prevent future exacerbations. Education on trigger avoidance, the proper use of inhaler techniques, and a review of her asthma action plan are also essential components of her care. The goal is to stabilize her condition and prevent the progression to more severe respiratory complications.

Section 2

The healthcare team decides to initiate systemic corticosteroids, specifically oral prednisone, to reduce airway inflammation and improve the patient's respiratory status. The patient is also started on a high-dose inhaled corticosteroid and a long-acting beta-agonist (LABA) combination inhaler for better long-term control. Over the next 24 hours, the patient receives close monitoring in a step-down unit, where continuous pulse oximetry shows her oxygen saturation fluctuating between 88% and 92% on supplemental oxygen at 2 liters per minute via nasal cannula. Her respiratory rate remains elevated at 28 breaths per minute, and she continues to exhibit increased work of breathing, although there is a slight reduction in accessory muscle use.

Despite the initiation of corticosteroids and adjustments to her inhaler regimen, the patient reports persistent dyspnea, particularly during minimal exertion, and her peak flow readings remain significantly below her personal best. A repeat ABG is performed, revealing a pH of 7.34, PaCO2 of 46 mmHg, and PaO2 of 62 mmHg. While there is a slight improvement in her acid-base balance, the hypoxemia persists, indicating ongoing ventilation-perfusion mismatch. The clinical team suspects that an undiagnosed complication, such as mucus plugging or atelectasis, might be contributing to her sustained respiratory distress.

In light of these findings, the decision is made to conduct a bronchoscopy to directly visualize the airways and assess for any obstructive lesions or mucus plugs that could be exacerbating her asthma. This procedure aims to provide both diagnostic clarity and therapeutic intervention, as bronchoscopic suctioning may relieve some of the airway obstruction. The healthcare team also revisits her asthma action plan, emphasizing the importance of adherence to her medication regimen and recognizing early warning signs of exacerbation. This evolving scenario highlights the complexity of asthma management and the necessity of a multifaceted approach to prevent further deterioration in her respiratory status.

Section 3

Following the bronchoscopy, the healthcare team discovers significant mucus plugging in the patient's lower airways, contributing to her ventilation-perfusion mismatch and sustained respiratory distress. The procedure successfully removes several mucus plugs, leading to an immediate yet modest improvement in her oxygenation, with her oxygen saturation rising to 94% on 2 liters per minute of supplemental oxygen. However, her respiratory rate remains elevated at 26 breaths per minute, and she continues to experience moderate dyspnea with minimal exertion. The patient is closely monitored for any signs of bronchospasm or bleeding post-procedure, and her vital signs are stable, though she reports feeling fatigued.

The team reviews her repeat chest X-ray, which shows partial resolution of atelectasis in the previously affected areas, supporting the effectiveness of the bronchoscopy in relieving airway obstruction. Despite these findings, the persistence of her symptoms prompts a re-evaluation of her asthma management plan. The clinical team decides to increase her inhaled corticosteroid dosage and add a short course of oral antibiotics due to the potential of an underlying bacterial infection contributing to her mucus production and exacerbation. Additionally, a sputum culture is ordered to identify any infectious organisms that may require targeted treatment.

As the patient's condition evolves, the healthcare team recognizes the importance of ongoing education for both the patient and her family. They emphasize the need for strict adherence to her updated medication regimen, proper inhaler technique, and the significance of regular follow-up appointments to monitor her asthma control. The team also discusses the potential need for further investigations, such as a pulmonary function test or CT scan, should her symptoms not improve. This comprehensive approach aims to prevent further complications and ensure a more stable respiratory status moving forward.

Section 4

A few days after the bronchoscopy and adjustment in her treatment plan, the patient presents for a follow-up appointment with her healthcare team. During the evaluation, she reports some improvement in her breathing, but still experiences episodes of wheezing and chest tightness, particularly at night. Her family mentions noticing her cough has become more productive, with yellow-green sputum over the past two days. On examination, her vital signs reveal a respiratory rate of 22 breaths per minute, a heart rate of 88 beats per minute, and an oxygen saturation of 95% on room air. Auscultation reveals scattered wheezes and diminished breath sounds at the lung bases. The patient's peak expiratory flow rate is measured at 70% of her personal best, indicating suboptimal asthma control despite recent interventions.

The team reviews the results of the sputum culture, which identify the presence of Haemophilus influenzae, a common respiratory pathogen that can exacerbate asthma symptoms. This finding corroborates the decision to initiate antibiotics and underscores the need to continue this treatment course. In light of the ongoing symptoms and new bacterial findings, the healthcare team decides to extend the antibiotic therapy for an additional week and considers introducing a leukotriene receptor antagonist to further reduce inflammation and improve her asthma control.

Given these developments, the team emphasizes the need for vigilant monitoring of the patient's response to the updated management plan. They stress the importance of adherence to the medication regimen and proper inhaler technique, offering additional education and resources to the patient and her family. Moreover, they schedule a follow-up pulmonary function test to assess lung function more comprehensively and to determine if further adjustments are necessary. This careful monitoring and tailored intervention strategy aim to prevent new complications, such as potential airway remodeling or further exacerbations, thereby guiding the patient toward achieving stable asthma control.

Section 5

Two weeks into the updated treatment plan, the patient returns for a follow-up appointment with her healthcare team. Despite adherence to the prescribed regimen, she reports persistent nocturnal symptoms, including wheezing and chest tightness, though she notes a slight decrease in the frequency of her daytime cough. The previously productive cough has diminished, but she now experiences increased fatigue and a sensation of tightness in her chest throughout the day. On examination, her vital signs reveal a respiratory rate of 24 breaths per minute, an increased heart rate of 94 beats per minute, and a decreased oxygen saturation of 92% on room air, indicating a potential decline in respiratory status.

A repeat pulmonary function test reveals a peak expiratory flow rate at 60% of her personal best, showing further deterioration in her asthma control. Auscultation continues to reveal scattered wheezes, and breath sounds remain diminished at the lung bases. The healthcare team decides to conduct further diagnostic testing, including a chest X-ray, to rule out any potential complications such as pneumonia or atelectasis that may be contributing to her worsening condition. Blood tests are also ordered to assess for elevated white blood cell count or other inflammatory markers that could indicate systemic involvement.

These developments prompt the healthcare team to re-evaluate the patient's management plan. The consideration of systemic corticosteroids is discussed to address the heightened inflammation, alongside close monitoring of her oxygen saturation levels. Education is reinforced regarding the importance of recognizing early signs of exacerbation and ensuring a rapid response. This approach aims to stabilize her condition and prevent further decline, setting the stage for a comprehensive evaluation of her asthma management and lifestyle adjustments that may be necessary to improve her quality of life.