ACUTE ASTHMA MANAGEMENT GERI CASE STUDY WITH COMPLETE SOLUTIONS
Case Study Acute Asthma Management
Difficulty: Intermediate
2 Respiratory Disorders
Setting: Outpatient clinic
Index Words: asthma, allergies, respiratory distress, patient education, assessment, aerosol treatment, inhaler
Giddens Concepts: Gas Exchange, Oxygenation, Patient Education, Safety
HESI Concepts: Assessment, Gas Exchange, Nursing Interventions, Oxygenation, Patient Education, Safety
▶ Scenario
B.T., a 31-year-old man who lives in a small mountain town in Colorado, is highly allergic to dust and pol-
len and has a history of mild asthma. B.T.'s wife drove him to the emergency room when his wheezing was
unresponsive to his fluticasone/salmeterol (Advair) inhaler, he was unable to lie down, and he began to
use accessory muscles to breathe. B.T. is immediately started on 4 L oxygen by nasal cannula and intrave-
nous (IV) D5W at 75 mL/hr. A set of arterial blood gases is sent to the laboratory. B.T. appears anxious and
says that he is short of breath.
Chart View
Vital Signs
Blood pressure (BP) 152/84 mm Hg
Pulse rate 124 beats/min
Respiratory rate 42 breaths/min
Temperature 100.4 ° F (38.4 ° C)
1. Are B.T.'s vital signs acceptable? State your rationale.
No. The patient dyspnea is the results of his increased in heart rate and respiratory rate. The increas
in BP will be due to anxiety and he has a fever based on his temperture of 100.4
2. What is the rationale for immediately starting B.T. on O2?
Asthma causes the to be inflamed and swollen which will contract the airway making it diffcult for the
patient to breath.
3. Keeping in mind B.T.'s health history and presenting complaint, what are the most important
areas you need to evaluate during your physical assessment?
I will need to do a focus assesment on the patient's chest.
, PART 1 MEDICAL-SURGICAL CASES
Chart View
Arterial Blood Gases
2 Respiratory Disorders
pH 7.31
PaCO 48 mm Hg
HCO3 26 mmol/L
PaO 55 mm Hg
4. Interpret B.T.'s arterial blood gas results.
Respiratory acidosis
Chart View
Medication Orders
Albuterol 2.5 mg plus ipratropium 250 mcg nebulizer treatment STAT
Albuterol (Ventolin) inhaler 2 puffs q4h
Metaproterenol sulfate (Alupent) 0.4% nebulizer treatment q3h
Fluticasone (Flovent HFA) MDI: 220 mcg, 1 puff twice daily
5. What is the rationale for the albuterol 2.5 mg plus ipratropium 250 mcg nebulizer treatment
STAT (immediately)? The patient is having shortness of breath and albuterol relaxes the muscle in
the airway increasing air flow to the lungs
6. Indicate the drug classification and expected outcome B.T. should experience with using
metaproterenol sulfate (Alupent) and Fluticasone (Flovent). Metaproterenol is a bronchodilator adrenergics it
increases air flow to the lungs. Fluticasone is an anti-inflammatories corticosteriods decrease allergic
Case Study Acute Asthma Management
Difficulty: Intermediate
2 Respiratory Disorders
Setting: Outpatient clinic
Index Words: asthma, allergies, respiratory distress, patient education, assessment, aerosol treatment, inhaler
Giddens Concepts: Gas Exchange, Oxygenation, Patient Education, Safety
HESI Concepts: Assessment, Gas Exchange, Nursing Interventions, Oxygenation, Patient Education, Safety
▶ Scenario
B.T., a 31-year-old man who lives in a small mountain town in Colorado, is highly allergic to dust and pol-
len and has a history of mild asthma. B.T.'s wife drove him to the emergency room when his wheezing was
unresponsive to his fluticasone/salmeterol (Advair) inhaler, he was unable to lie down, and he began to
use accessory muscles to breathe. B.T. is immediately started on 4 L oxygen by nasal cannula and intrave-
nous (IV) D5W at 75 mL/hr. A set of arterial blood gases is sent to the laboratory. B.T. appears anxious and
says that he is short of breath.
Chart View
Vital Signs
Blood pressure (BP) 152/84 mm Hg
Pulse rate 124 beats/min
Respiratory rate 42 breaths/min
Temperature 100.4 ° F (38.4 ° C)
1. Are B.T.'s vital signs acceptable? State your rationale.
No. The patient dyspnea is the results of his increased in heart rate and respiratory rate. The increas
in BP will be due to anxiety and he has a fever based on his temperture of 100.4
2. What is the rationale for immediately starting B.T. on O2?
Asthma causes the to be inflamed and swollen which will contract the airway making it diffcult for the
patient to breath.
3. Keeping in mind B.T.'s health history and presenting complaint, what are the most important
areas you need to evaluate during your physical assessment?
I will need to do a focus assesment on the patient's chest.
, PART 1 MEDICAL-SURGICAL CASES
Chart View
Arterial Blood Gases
2 Respiratory Disorders
pH 7.31
PaCO 48 mm Hg
HCO3 26 mmol/L
PaO 55 mm Hg
4. Interpret B.T.'s arterial blood gas results.
Respiratory acidosis
Chart View
Medication Orders
Albuterol 2.5 mg plus ipratropium 250 mcg nebulizer treatment STAT
Albuterol (Ventolin) inhaler 2 puffs q4h
Metaproterenol sulfate (Alupent) 0.4% nebulizer treatment q3h
Fluticasone (Flovent HFA) MDI: 220 mcg, 1 puff twice daily
5. What is the rationale for the albuterol 2.5 mg plus ipratropium 250 mcg nebulizer treatment
STAT (immediately)? The patient is having shortness of breath and albuterol relaxes the muscle in
the airway increasing air flow to the lungs
6. Indicate the drug classification and expected outcome B.T. should experience with using
metaproterenol sulfate (Alupent) and Fluticasone (Flovent). Metaproterenol is a bronchodilator adrenergics it
increases air flow to the lungs. Fluticasone is an anti-inflammatories corticosteriods decrease allergic
