Case Scenario:
B.T. is a 7-year-old who has been brought to the emergency department (ED) by her parent. They immediately tell you B.T. has a history of ED visits for her asthma. B.T. uses an inhaler when she wheezes, but it ran out a month ago. They are a single parent and have two other children at home with a babysitter. Your assessment finds B.T. alert, oriented, but extremely anxious. Her color is pale, and her nail beds are dusky and cool to the touch. The other findings are heart rate (HR) 140 beats/min, respiratory rate (RR) 36 breaths/min with a prolonged expiratory phase, oral temperature 99.1° F (37.3° C), Spo2 88%, breath sounds decreased in lower lobes bilaterally and congested with inspiratory and expiratory wheezes, and a productive cough. As you ask B.T.'s parent questions, you note that B.T.'s RR is increasing; she is sitting on the side of the bed, leaning slightly forward, and is having difficulty breathing. You are concerned that she is experiencing status asthmaticus.
1. You check the orders and need to decide which interventions are the priority at this time.
Select all that apply and explain the rationale.
a. Monitor HR and RR every 2 hours
b. Administer oxygen via face mask to keep Spo2 above 90%
c. Have L.S. lie flat
d. Administer albuterol (Proventil) and ipratropium bromide (Atrovent) via hand-held nebulizer (HHN) STAT
e. Reassess in 20 minutes, and if no improvement, administer salmeterol (Serevent Diskus) via dry-powder inhaler (DPI)
f. Start IV normal saline (NS) at 15mL/hr and administer methylprednisolone 2mg/kg IV STAT×1 dose
g. Have L.S. perform incentive spirometry
h. Encourage PO fluids as tolerated
2. Identify the nursing responsibilities associated with giving albuterol. Need Assignment Help?
Case Study Progress
You give B.T. the albuterol and Atrovent. Her O2 saturation does not improve and remains at 88% with oxygen at 6L/min via facemask. She says she "does not feel any better." She is retracting and RR rate remains 34 breaths/minute. You have started her IV infusion and administered the methylprednisolone. B.T.'s parent is pacing and tells you they are very upset and worried. You overhead page the attending ED resident to assess, and you notify the patient-family advocate. The ED resident, Dr. J., arrives within 2 minutes to assess B.T. and to speak to her parent. New orders are pending.
3. Chart your actions and the patient's response (SBAR format).
Case Study Progress
B.T. is admitted to the pediatric intensive care unit (PICU) for close monitoring. Her condition improves, and 24 hours later is transferred to the floor. Asthma teaching is ordered. You assess the parent's understanding of asthma and their understanding of the disorder.
4. Which of these statements by the parent would indicate a need for further teaching?
a."He should go to the doctor regularly to make sure his asthma is being treated correctly."
b."If he takes medications for a while, he will outgrow his asthma."
c. "Part of his treatment should be avoiding things that irritate his lungs."
d. "If I recognize early warning signs, he might be able to take medicine and not go to the ED."
5. You are educating B.T. and her parent on possible asthma triggers in their environment.
They live in public housing in an apartment without air conditioning. Which of these statements indicate possible asthma triggers? Select all that apply, and discuss strategies to avoid these triggers.
a. "The building has copper pipes."
b. "He coughs when we have cold nights after a warm day."
c. "We have a pet fish."
d. "There are hardwood floors."
e. "L. collects stuffed animals."
f. "Our visitors smoke outside."
g. "There are dark stains in our bathroom."
h. "The housing authority puts a foam down for bugs."