What is the primary non-invasive intervention the nurse should implement to help the patient manage mild respiratory distress due to asthma?

C) Have the patient sit in an upright position

A) Encourage the patient to lie flat

B) Administer supplemental oxygen

C) Have the patient sit in an upright position

What is the most appropriate initial nursing intervention for a patient experiencing mild respiratory distress due to asthma?

B) Encourage the patient to sit in an upright position

A) Administer oxygen via nasal cannula

B) Encourage the patient to sit in an upright position

C) Prepare for immediate intubation

D) Start an IV for potential medication administration

Which intervention is most appropriate for a patient experiencing mild asthma exacerbation with symptoms of wheezing and chest tightness?

A) Administering a dose of albuterol via inhaler

B) Providing supplemental oxygen at 4 L/min via nasal cannula

C) Initiating an intravenous corticosteroid drip

D) Giving a dose of oral antihistamine

Which of the following indicates that the patient is responding positively to the asthma interventions?

C) Oxygen saturation improvement to 98% on room air

A) Blood pressure increase to 140/90 mmHg

B) Heart rate increase to 110 bpm

C) Oxygen saturation improvement to 98% on room air

D) Respiratory rate increase to 24 breaths per minute

Which of the following is a key reason for a patient with asthma to regularly monitor their peak flow readings?

A) To identify early signs of an asthma exacerbation

B) To eliminate the need for regular medication use

C) To assess blood oxygen levels

D) To replace the need for medical check-ups

What is the primary reason for a nurse to educate a patient with asthma about maintaining a peak flow diary?

B) To identify early signs of asthma exacerbation

A) To monitor medication side effects

B) To identify early signs of asthma exacerbation

C) To track daily dietary intake

D) To document physical activity levels

What is the primary purpose of adding a low-dose inhaled corticosteroid to the patient's asthma management plan?

A) To immediately relieve symptoms of shortness of breath

C) To increase the patient's peak flow readings instantly

D) To replace the need for a rescue inhaler entirely

What is the primary purpose of prescribing a low-dose inhaled corticosteroid for this patient with asthma?

B) To reduce airway inflammation and prevent exacerbations

A) To dilate the airways during an acute asthma attack

B) To reduce airway inflammation and prevent exacerbations

C) To provide immediate relief of shortness of breath

D) To increase oxygen saturation levels quickly

Which of the following actions should the nurse emphasize to the patient to minimize the risk of oral thrush when using inhaled corticosteroids?

C) Rinse the mouth with water after using the inhaler

A) Use a spacer with the inhaler

B) Drink a glass of water before using the inhaler

C) Rinse the mouth with water after using the inhaler

D) Inhale deeply and hold breath for 10 seconds after inhalation

What is the most appropriate nursing intervention to minimize the risk of oral thrush in a patient using inhaled corticosteroids?

C) Encourage the patient to rinse their mouth with water after inhaler use.

A) Instruct the patient to use a spacer with the inhaler.

B) Advise the patient to drink water before using the inhaler.

C) Encourage the patient to rinse their mouth with water after inhaler use.

D) Recommend avoiding dairy products after inhaler use.

respiratory distress - Nursing Case Study

Pathophysiology

• Primary mechanism: Inadequate oxygen exchange occurs when alveoli, the tiny air sacs in the lungs, are filled with fluid or collapsed, preventing oxygen from entering the bloodstream efficiently.

• Secondary mechanism: Airway obstruction can happen due to swelling, mucus, or foreign bodies, leading to reduced airflow and increased effort to breathe.

• Key complication: This can lead to hypoxemia, a condition where there is a deficiency of oxygen in the blood, causing symptoms like rapid breathing and increased heart rate as the body attempts to compensate.

Patient Profile

Demographics:

32-year-old male, office worker

History:

• Key past medical history: Mild intermittent asthma diagnosed at age 25

• Current medications: Albuterol inhaler as needed

• Allergies: No known drug allergies

Current Presentation:

• Chief complaint: Mild shortness of breath

• Key symptoms: Mild wheezing, slight chest tightness, no cough or fever

• Vital signs: Blood pressure 118/78 mmHg, Heart rate 82 bpm, Respiratory rate 18 breaths per minute, Temperature 98.4°F, Oxygen saturation 97% on room air

Section 1

Initial Assessment Findings:

Upon initial assessment, the patient presents with mild respiratory distress. The nurse notes that the patient is alert and oriented, but appears slightly anxious due to the sensation of breathlessness. There is mild wheezing audible upon auscultation of the lungs, particularly in the expiratory phase, which is consistent with his history of asthma. The patient reports feeling a slight tightness in his chest, which he rates as 3 out of 10 in terms of discomfort. His skin color is normal, and there are no signs of cyanosis. The nurse also observes that the patient's use of accessory muscles for breathing is minimal, indicating that his respiratory distress is not severe at this point.

The patient's vital signs are stable: blood pressure is 118/78 mmHg, heart rate is 82 bpm, respiratory rate is 18 breaths per minute, and oxygen saturation is 97% on room air. These findings suggest that while the patient is experiencing mild respiratory symptoms, his oxygenation and overall hemodynamic status are currently stable. Given his mild intermittent asthma, the nurse considers whether recent exposure to allergens or respiratory irritants could have contributed to his symptoms. Additionally, the nurse reviews the patient's use of his albuterol inhaler to ensure adherence to his asthma action plan and assesses his understanding of when and how to use it effectively.

Based on the initial assessment, the nurse decides to implement simple, non-invasive interventions. The patient is encouraged to sit in an upright position to facilitate easier breathing and is given reassurance to help alleviate his anxiety. Education is provided on proper inhaler technique, and the patient is encouraged to use his albuterol inhaler as prescribed. The nurse plans to monitor the patient closely for any changes in respiratory status or vital signs, ready to escalate care if necessary, while also considering environmental factors that could be contributing to this episode.

Section 2

Response to Interventions:

Approximately 30 minutes after the initial interventions, the patient reports feeling more at ease. He states that his breathing has become less labored and he feels less chest tightness, now rating it at a 1 out of 10. The nurse observes that the patient's anxiety has noticeably decreased, and he appears more relaxed. Upon reassessment, the wheezing upon auscultation of the lungs has diminished, and the patient's respiratory effort seems more regular. The patient confirms he has used his albuterol inhaler as prescribed, and he expresses confidence in his inhaler technique following the nurse's education.

Vital signs are re-evaluated: blood pressure remains stable at 116/76 mmHg, heart rate is slightly reduced at 78 bpm, respiratory rate is steady at 16 breaths per minute, and oxygen saturation has improved to 98% on room air. These findings suggest that the patient's respiratory distress has alleviated with the non-invasive interventions and inhaler use, indicating a positive response. The nurse continues to monitor the patient closely, as he relaxes in an upright position, ensuring there are no further changes in his condition.

As the patient stabilizes, the nurse discusses potential triggers that may have caused the mild exacerbation, reinforcing the importance of avoiding known allergens and irritants. The patient is receptive to this information and plans to be more vigilant about his environment. With the situation currently under control, the nurse prepares to discharge the patient with instructions to follow up with his primary care provider and to seek care if symptoms worsen or do not improve with his asthma action plan. The patient's journey continues with a focus on prevention and self-management for future episodes.

Section 3

As the patient prepares for discharge, the nurse receives new diagnostic results from the routine blood work that was conducted upon the patient's initial presentation. The complete blood count (CBC) reveals a slightly elevated eosinophil count, suggesting a possible allergic component contributing to the patient's respiratory distress. The nurse explains these findings to the patient, emphasizing the importance of identifying and managing potential allergens that may be exacerbating his asthma. This aligns with the earlier discussion about avoiding known triggers and reinforces the need for the patient to be proactive in his asthma management.

Additionally, a peak flow measurement conducted earlier in the assessment shows a moderate decrease from the patient's personal best, which the nurse uses as a teaching opportunity. The nurse explains the significance of monitoring peak flow readings regularly to detect early signs of an exacerbation and adjust the asthma action plan accordingly. The patient is encouraged to maintain a peak flow diary to track his lung function over time and recognize patterns that might indicate worsening symptoms.

The nurse also discusses the importance of regular follow-up appointments with the patient's primary care provider to reassess his asthma management plan and consider the potential need for adjustments in medication. By reinforcing these educational points and ensuring the patient understands the importance of self-monitoring, the nurse equips him with the knowledge to prevent future exacerbations. As the patient expresses understanding and appreciation for the guidance provided, he is discharged with the necessary resources and instructions, feeling more confident in managing his condition.

Section 4

Several weeks after his discharge, the patient returns to the clinic for a follow-up appointment. During this visit, he reports adhering to his asthma action plan and actively avoiding known allergens, but he mentions experiencing occasional shortness of breath, particularly during physical activity. The nurse conducts an initial assessment, noting that the patient's vital signs are stable: blood pressure is 120/78 mmHg, heart rate is 82 beats per minute, respiratory rate is 18 breaths per minute, and oxygen saturation is 96% on room air. However, upon auscultation, mild wheezing is detected in the lower lung fields, suggesting some airflow limitation.

The nurse reviews the patient's peak flow diary and observes a pattern of fluctuating readings, with several instances showing a significant drop from his personal best. This indicates that despite his efforts, the patient's asthma is not fully controlled. The nurse discusses these findings with the patient, emphasizing the importance of recognizing the early warning signs of an exacerbation and the need for timely intervention. The patient acknowledges that he sometimes delays taking his rescue inhaler, thinking the symptoms will resolve on their own.

In light of these observations, the nurse collaborates with the patient's primary care provider to adjust his asthma management plan. The decision is made to initiate a low-dose inhaled corticosteroid to help reduce airway inflammation and prevent future exacerbations. The nurse educates the patient on the correct use of the inhaler, the importance of adherence to the prescribed regimen, and the need for ongoing monitoring of symptoms and peak flow readings. With a revised plan in place and a clearer understanding of his condition, the patient leaves the clinic feeling better equipped to manage his asthma effectively.

Section 5

Several weeks later, the patient returns to the clinic for another follow-up appointment. The nurse begins with an initial assessment and notes that the patient's vital signs remain stable: blood pressure is 118/76 mmHg, heart rate is 80 beats per minute, respiratory rate is 16 breaths per minute, and oxygen saturation is 98% on room air. The patient reports feeling better overall and has not experienced any significant episodes of shortness of breath since the last visit. He attributes this improvement to his consistent use of the inhaled corticosteroid and better adherence to his asthma action plan.

During auscultation, the nurse detects only mild wheezing in the lower lung fields, which is an improvement from the previous visit. The patient's peak flow diary shows more stable readings, with fewer fluctuations and no significant drops from his personal best. However, the patient mentions experiencing a dry cough occasionally, particularly at night. The nurse considers this new symptom in the context of the recent medication change and the known side effect profile of inhaled corticosteroids.

To address the nocturnal cough, the nurse consults the primary care provider, who recommends a slight adjustment to the inhalation technique to minimize throat irritation. The nurse reviews the correct inhaler technique with the patient, ensuring he rinses his mouth after each use to prevent any potential side effects. The patient expresses relief at having a clear plan to manage his symptoms and feels more confident in his ability to control his asthma. With ongoing education and support, the patient is encouraged to continue regular follow-up appointments to monitor his progress and address any emerging issues promptly.